Combining a Brain Scan with a Spinal Fluid Test


Contributed by: Dennis Fortier, President, Medical Care Corporation
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According to a study published in the latest issue of Archives of Neurology, researchers at University College London's Institute of Neurology have collected evidence of a correlation between two interesting brain pathologies. The research looked at low levels of beta-amyloid in the spinal fluid and, based on an MRI brain scan twelve months later, the rate of brain atrophy (or shrinkage).

The interest in this study stems from prior research showing that a low level of amyloid in the cerebral spinal fluid (CSF) is a common (but not certain) precursor to Alzheimer's disease. Furthermore, typical Alzheimer's pathology includes the death of brain cells leading to brain shrinkage. Therefore, noting that these two indicators seem to move in unfavorable directions, even before symptoms are present, might lead to methods for earlier detection and intervention.

In general, the expert research community supports the notion of combining indicators to detect early trends that should be carefully monitored. While this study is certainly noteworthy, coverage in the media, that has portrayed these findings as a method for detecting early stage Alzheimer's disease, is probably over-stated at this early point.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Does Early Diagnosis of Alzheimer's Really Create an Ethical Dilemma?


Contributed by: Dennis Fortier, President, Medical Care Corporation
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Does early diagnosis of Alzheimer's really create an ethical dilemma?

For all of the press devoted to scrutinizing the pros and cons of delivering an Alzheimer's diagnosis to a patient with only mild symptoms, including a front page article in today's NY Times, it is easy to overlook the question posed above. In fact, anyone could be forgiven if they assumed, based on the constant characterization in the press, that a dilemma is at hand.

The Dilemma That Isn't

Posing this question may generate provocative headlines and robust debate but, if we step back and consider the larger context, there really is no dilemma. We do not need any ethicists to ponder and rule on this question because it doesn't require a single, universal answer.

Some people seek clinical information and get comfort from having it available, even when the information consists of bad news like an Alzheimer's diagnosis. Others prefer ignorance when new information will cause them to worry needlessly about a situation they cannot change.

Patients Choose
Rather than debating which approach is better and pronouncing the presence of a dilemma, all we need to do is let individuals choose their preference. Those who want to know should be told; those who do not want to know, needn't have the information thrust upon them. When someone has a sign or symptom of a medical problem and then seeks a physician's opinion about the underlying problem, they are pretty much declaring that they want a diagnosis. In the real world, the "want-to-know vs. don't-want-to-know" decision is made by either consulting a physician or not.

This situation is not as black and white as described here, but it certainly is far less gray than characterized by the press. In general, people seeking medical attention for a cognitive complaint want help and physicians have an obligation to diagnose the problem and treat it as effectively as possible.

Sometimes this will involve giving patients news they would rather not hear, but the symptoms and the angst that comes with those symptoms, are already a reality in the patient's lives. A definitive diagnosis reduces uncertainty and helps the treatment process move optimally forward.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Could Alzheimer's be Caused by Inflammation?


Contributed by: Dennis Fortier, President, Medical Care Corporation
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As with all unsolved scientific problems, hypotheses are constantly developed, modified, and tested with each new study shaping the ongoing debate in some way. In terms of the question "What Causes Alzheimer's?", the hypothesis that inflammation is the culprit has long been discussed and, to some degree, tested in the lab.

The LA Times ran an interesting article this week highlighting the inflammation hypothesis and describing its merits. It's a good overview of a theory that is not considered central by leading thinkers today, but may well have merit.

One quote in the article suggests that this is a "very new" way of thinking about the problem, but that is not really true. Inflammation has been fairly well scrutinized for its role in the Alzheimer's disease process. The current scientific emphasis elsewhere (primarily on the amyloid hypothesis), merely suggests that inflammation is not the most compelling avenue according to most of the experts in the field.

However, most would agree that inflammation may play some role in the complex cascade of pathology associated with this disease.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Congress Passes Nat'l Alzheimer's Prevention Act


Contributed by: Dennis Fortier, President, Medical Care Corporation
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The passing of the National Alzheimer's Prevention Act is good news; another solid step in the right direction.

One of the common theories about why a solution to the Alzheimer's problem has been elusive, is that we have no national strategy coordinating a game plan. In lieu of such a coordinated approach, we have arguably ignored pockets of potential scientific importance, squandered funding by over-studying fruitless theories, and failed to learn about and share effective community programs from around the country.

There is no doubt that it is a difficult puzzle to solve and that the cost of solving it more slowly than necessary is enormous. Perhaps even incalculable.

It makes sense that an efficient approach would include an effort to ensure that scientific resources are focused on carefully selected initiatives with minimal overlap, that social programs are carefully vetted for efficacy and then pragmatically supported in the public sector, and that available research funding is directed in a comprehensively thoughtful manner.

All of these principles are captured in the spirit of the National Alzheimer's Prevention Act. Specifically, it requires that the Department of Health and Human Services will appoint an inter-agency council to recommend a national plan of action.

You can also help by urging the President to support this effort. Click here to do your part.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Understanding Cholesterol and Alzheimer's Risk


Contributed by: Dennis Fortier, President, Medical Care Corporation
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As we have often noted, cardiovascular risk factors including high blood pressure, obesity, and high overall cholesterol can increase the likelihood of getting Alzheimer's disease (AD). A study published earlier this week in the Archives of Neurology may have shed more particular light on the relationship between cholesterol and AD.

According to researchers at Columbia University, high levels of HDL cholesterol (the "good" form), are 60% less likely to develop AD. They followed 1,130 seniors with no history of memory loss or dementia and measured their cholesterol levels every 18 months for four years. Their findings supported the theory that high levels of HDL cholesterol are correlated with lower incidence of AD.

While this has excellent face validity in that high HDL levels have been correlated with better cardiovascular heatlh in other studies, there is no compelling biological explanation of how or why elevated HDL's would reduce risk for AD. Also, earlier studies on HDL's and AD, conducted by the National Institute on Aging, showed the opposite result. That is, high HDL cholesterol was correlated with a higher risk of AD.

The relationship between cholesterol and AD risk is an area of ongoing study with many questions yet unanswered. However, based on the well documented vascular benefits of controlled cholesterol, it is wise to keep overall cholesterol and HDL cholesterol within the established ranges of good health.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Memory Assessment During Routine Medical Exams


Contributed by: Dennis Fortier, President, Medical Care Corporation
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As we have noted in this space before, the Health Care Reform Act will mandate "detection of cognitive impairment" during routine Medicare Exams beginning in 2011. However, the approach by which physicians will comply with this new requirement remains an open question.

How should cognitive impairment be detected in a primary care setting?

The merit of any particular solution must be judged on several factors. For example, with all other factors held equal, a brief test would be superior to a short test as would a non-invasive test be superior to an invasive one. Cost matters as well; surely a less expensive test is preferable to a costly one. Similarly, a test that is highly sensitive to even subtle declines in cognition would be a better solution than one that only detects more severe symptoms.

While I have described attributes for comparing "tests", it may be that a test need not be part of the ideal solution. Perhaps physicians need only be proactive in soliciting memory concerns (or other cognitive complaints) from their patients.

Under such a scenario, those who express a concern could advance to a more sophisticated evaluation and the others would be questioned again at their next annual wellness exam. That's not a perfect solution for detecting problems in patients who are not already concerned, but many experts in this space would argue that such an approach would be a major leap forward. In fact, it might be the only approach that blends enough pragmatism and cost-efficacy to actually work in a busy primary care setting.

I recently listened to a webimar about a brief instrument called the "AD8", an informant-based questionnaire that could be useful in helping physicians identify patients who need a more thorough evaluation of their cognition. Various participants from the audience, many with ties to competing instruments, raised concerns about the whether or not it was a viable solution. An expert panel then discussed various pros and cons of the AD8 during the ensuing dialogue. The point of this post is not to evaluate the AD8 but to highlight the value of a new focus on cognitive health.

From my perspective, the facts that (1) Health Care reform is mandating more attention to cognitive health and (2) national discussions are unfolding to explore competing approaches, are both extremely positive developments. Memory concerns must be identified and addressed as early as possible to ensure timely intervention against progressive illnesses. This is our best bet to avoid future insolvency of our public health care system.

Efforts to initiate discussions about brain health between patients and their physicians are exactly what we need. We are on the right track.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Crossing the Blood/Brain Barrier

Contributed by: Dennis Fortier, President, Medical Care Corporation
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This is a topic of towering importance in the field of treating brain disorders.

As we have discussed here previously, the brain is protected from foreign substances in the blood stream by a sophisticated barrier that is difficult to cross. This protective barrier is key to maintaining brain health but poses a challenge for scientists developing treatments that target the brain because, in very many instances, the treatment cannot cross from the blood stream to the brain where it can interact directly with the intended pathological target.

As researchers continue to develop hypotheses and investigate novel approaches for crossing the blood/brain barrier, the general media reports on these efforts with regularity. While there is no definitive breakthrough as yet, I think it is an important topic to follow.

Today I am highlighting a summary of thinking from researchers at Rensselaer Polytechnic Institute. I encourage you to click through this link and read the summary.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.